4187F Disease modifying anti-rheumatic drug therapy prescribed or dispensed (RA)

Name of the Procedure:

Disease Modifying Anti-Rheumatic Drug (DMARD) Therapy Prescribed or Dispensed (RA)

Summary

Disease Modifying Anti-Rheumatic Drugs (DMARDs) are medications used to treat rheumatoid arthritis (RA) by slowing down the disease's progression and managing symptoms, such as pain and inflammation.

Purpose

Medical Condition:

• Rheumatoid Arthritis (RA)

Goals:

• Reduce joint inflammation
• Prevent joint and tissue damage
• Preserve joint function and mobility
• Improve overall quality of life for RA patients

Indications

Specific Symptoms:

• Persistent joint pain
• Swelling and stiffness in multiple joints
• Fatigue and general feeling of unwellness

Patient Criteria:

• Diagnosed with rheumatoid arthritis
• Inadequate response to non-steroidal anti-inflammatory drugs (NSAIDs) or other initial treatments

Preparation

Pre-procedure Instructions:

• Complete any recommended blood tests to assess baseline organ function (e.g., liver, kidneys)
• Review current medications with healthcare provider to avoid interactions
• Possibly fasting, if instructed by the healthcare provider

Diagnostic Tests:

• Blood tests (complete blood count, liver enzymes, etc.)
• Baseline imaging (X-ray, MRI, or ultrasound of affected joints)

Procedure Description

Steps:

1. Initial Assessment:

   • Detailed discussion with healthcare provider about the patient's medical history, symptoms, and treatment goals.

2. Prescription:

   • Selection of appropriate DMARD based on the patient's condition and medical history (e.g., methotrexate, sulfasalazine, hydroxychloroquine).

3. Dispensing:

   • Medication prescribed, patient receives specific dosage instructions.

4. Monitoring Plan:

   • Regular follow-up appointments scheduled to monitor effectiveness and side effects.
   • Periodic blood tests to check for adverse effects on liver or blood counts.

Tools and Equipment:

• Prescription pad or electronic medical record system
• Blood test kits for monitoring (if needed)

Anesthesia or Sedation:

• Not applicable for this procedure

Duration

• Initial consultation: 30-60 minutes
• Follow-up appointments: 15-30 minutes each
• Duration of therapy: Can be long-term, potentially years

Setting

• Outpatient clinic or doctor's office

Personnel

• Rheumatologist or primary care physician
• Pharmacist for medication dispensing
• Nurse practitioner or physician assistant for follow-up care

Risks and Complications

Common Risks:

• Gastrointestinal upset
• Increased risk of infections
• Elevated liver enzymes

Rare Risks:

• Severe infections
• Blood disorders
• Pulmonary toxicity

Management:

• Immediate reporting of side effects
• Regular monitoring through blood tests and clinical assessments

Benefits

• Relief from joint pain and swelling
• Slowing or halting of disease progression
• Preservation of joint function
• Improved ability to perform daily activities

Recovery

Post-procedure Care:

• Regular follow-up visits
• Adherence to prescribed medication schedule
• Immediate reporting of any side effects or new symptoms

Recovery Time:

• No immediate recovery period since it is an ongoing treatment

Follow-up Appointments:

• Typically every 3-6 months, or as advised by the healthcare provider

Alternatives

Other Treatment Options:

• NSAIDs or corticosteroids for symptom relief
• Biological agents like TNF inhibitors
• Physical therapy

Pros and Cons:

• DMARDs are effective in slowing disease progression but require regular monitoring.
• Biological agents may offer faster relief but are more expensive and can have more severe side effects.

Patient Experience

During Procedure:

• Discussion of symptoms and treatment plan with healthcare provider
• Prescription received and filled

After Procedure:

• Regular medication intake
• Follow-up visits for monitoring
• Possible side effects manageable with close monitoring and communication with healthcare provider

Pain Management:

• Over-the-counter pain relievers as advised by the healthcare provider
• Proper reporting of any significant new pain or side effects to tailor the treatment plan